A structured yoga program added to standard buprenorphine treatment significantly accelerated recovery from opioid withdrawal and improved autonomic regulation in men with opioid use disorder, according to a randomized clinical trial published in JAMA Psychiatry.
The early-stage trial, conducted at an inpatient addiction medicine unit in India, enrolled 59 adult men aged 18 to 50 years who were experiencing mild to moderate opioid withdrawal. Patients were randomized to receive either standard pharmacologic care with buprenorphine alone or buprenorphine plus a 2-week, supervised yoga intervention. The primary outcomes were time to withdrawal stabilization and changes in heart rate variability (HRV), a physiological marker of autonomic nervous system balance.
Patients assigned to the yoga group reached withdrawal stabilization—defined as a sustained Clinical Opiate Withdrawal Scale score of less than 4—substantially faster than those receiving usual care alone. The median time to stabilization was 5 days in the yoga group compared with 9 days in the control group. In survival analyses adjusted for cumulative buprenorphine dose, the rate of recovery was more than fourfold higher with yoga.
In addition to faster clinical stabilization, yoga was associated with statistically significant improvements in autonomic regulation. Compared with controls, patients in the yoga group showed large increases in high-frequency HRV power and reductions in low-frequency power and the low-frequency/high-frequency ratio, indicating a shift away from sympathetic dominance. Mediation analyses suggested that increases in parasympathetic activity accounted for approximately 23% of yoga's effect on accelerated withdrawal recovery.
Secondary outcomes also favored yoga. Patients receiving the adjunct intervention experienced greater reductions in anxiety scores, measured by the Hamilton Anxiety Rating Scale, with a large effect size. They also reported moderate but statistically significant improvements in sleep latency—falling asleep an average of 61 minutes faster—and reductions in pain severity compared with controls.
The yoga intervention consisted of 10 supervised, 45-minute sessions delivered over 14 days by a certified therapist. The standardized module included relaxation practices, gentle postures, breathing techniques (pranayama), and guided relaxation. More than 90% of patients completed at least eight sessions, supporting the feasibility of implementing yoga even during acute withdrawal.
All patients received buprenorphine according to standard inpatient protocols, and medication doses did not differ significantly between groups, suggesting that the observed benefits were independent of pharmacologic optimization.
The researchers acknowledged several limitations, including the single-center design, short follow-up, absence of an active control condition, and the inclusion of only male patients, reflecting local patterns of opioid use. They called for larger, multisite trials with more diverse populations to confirm generalizability and to assess longer-term outcomes such as relapse and treatment retention.
Nevertheless, the results suggest that yoga may represent a low-cost, scalable, and neurobiologically informed adjunct to standard withdrawal care. According to the study, by improving autonomic balance alongside psychological and physical symptoms, yoga could help shorten the most vulnerable phase of treatment and potentially improve engagement and outcomes in opioid use disorder care.
Disclosures can be found in the study.
Source: JAMA Psychiatry
